Provider Demographics
NPI:1710181672
Name:WATSON, ALVIN F JR
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:F
Last Name:WATSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N FANT ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5720
Mailing Address - Country:US
Mailing Address - Phone:864-226-1166
Mailing Address - Fax:864-226-5647
Practice Address - Street 1:400 N FANT ST
Practice Address - Street 2:SUITE D
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5720
Practice Address - Country:US
Practice Address - Phone:864-226-1166
Practice Address - Fax:864-226-5647
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3808104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
55-0881025OtherTAX ID